Augmentation of Distal Biceps Tendon Ruptures With the Lacertus Fibrosus: A Biomechanical Study in a Tendon-Deficient Model

2022 ◽  
pp. 036354652110654
Author(s):  
Matthew R. LeVasseur ◽  
Antonio Cusano ◽  
Michael R. Mancini ◽  
Colin L. Uyeki ◽  
Matthew J. Pina ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Cost Effective ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Lacertus Fibrosus ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Tendon Ruptures ◽  
Repair Group ◽  
Cadaveric Model

Background: Chronic distal biceps tendon ruptures may require tendon graft augmentation secondary to tendon attrition or retraction. The lacertus fibrosus is a local, cost-effective graft that can be used to supplement reconstruction. Purpose: To compare the biomechanical strength of distal biceps tendon repairs with and without lacertus fibrosus augmentation in a tendon-deficient cadaveric model. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen matched cadaveric pairs of elbows were randomized into 2 groups: (1) standard distal biceps tendon repair and (2) tendon-deficient (50% step cut) repair with lacertus fibrosus augmentation. All repairs were completed using an oval bone trough and 2 double-loaded No. 2 braided nonabsorbable sutures in a locked Krackow fashion tied over a lateral bone bridge. For the lacertus augmentation group, the lacertus was wrapped circumferentially in a tubular fashion around the tendon to restore the native size and incorporated into the Krackow suture. All specimens underwent cyclic loading and then were loaded to failure. Displacement, stiffness, load to failure, and mode of failure were recorded. Results: The standard repair and lacertus augmentation groups had similar displacements on cyclic loading (1.66 ± 0.62 vs 1.62 ± 0.58 mm, respectively; P = .894). The stiffness was significantly greater for the standard repair group (21.3 ± 2.5 vs 18.5 ± 3.5 N/mm; P = .044). Both groups provided excellent mean peak load to failure strengths, despite the standard repair group having significantly greater strength (462.4 ± 140.5 vs 377.3 ± 101.1 N; P = .022). The primary mode of failure in the standard repair group was fracture at the bone bridge (n = 5/8) compared with suture pullout (n = 4/8) in the lacertus augmentation group. Conclusion: Lacertus fibrosus augmentation of a tendon-deficient biceps repair was less stiff and had lower mean load to failure compared with repair of the native tendon in this cadaveric model, but these values remained biomechanically acceptable above critical thresholds. Consequently, lacertus fibrosus augmentation is a viable option for chronic distal biceps tendon ruptures with tendon attrition. Clinical Relevance: Chronic distal biceps tendon ruptures may require autograft or allograft reconstruction secondary to tendon scarring, shortening, attrition, and degeneration. The lacertus fibrosus is a cost-effective and low-morbidity local autograft that can be used to augment repairs.

Lacertus Fibrosus Versus Achilles Allograft Reconstruction for Distal Biceps Tears: A Biomechanical Study

2017 ◽  
Vol 45 (14) ◽  
pp. 3340-3344 ◽  
Author(s):  
Anand M. Murthi ◽  
Miguel A. Ramirez ◽  
Brent G. Parks ◽  
Shannon R. Carpenter
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Biceps Tendon ◽  
Biceps Muscle ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Lacertus Fibrosus ◽  
Tendon Allograft ◽  
Load To Failure ◽  
Achilles Tendon Allograft

Background: The bicipital aponeurosis, or lacertus fibrosus, can potentially be used as a reconstruction graft in chronic distal biceps tendon tears. Purpose: To evaluate construct stiffness, load to failure, and failure mechanism with lacertus fibrosus versus Achilles allograft for distal biceps tendon reconstruction. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched cadaveric pairs of elbows were used. Three centimeters of the distal biceps tendon was resected. Specimens were randomized to the lacertus fibrosus or Achilles tendon group. In one group, the lacertus fibrosus was released from its distal attachment and then tubularized and repaired intraosseously to the radius. In the other group, an Achilles tendon graft was sutured to the biceps muscle and repaired to the ulna. The prepared radii were rigidly mounted at a 45° angle on a load frame. The proximal biceps muscle was secured in a custom-fabricated cryogenic grip. Displacement was measured using a differential variable reluctance transducer mounted at the radius–soft tissue junction and in the muscle- or muscle allograft–tissue junction proximal to the repair. Specimens were loaded at 20 mm/min until failure, defined as a 3-mm displacement at the radius–soft tissue junction. Results: No significant difference was found in mean load to failure between the lacertus fibrosus and Achilles tendon group (mean ± SD, 20.2 ± 5.5 N vs 16.89 ± 4.54 N; P = .18). Stiffness also did not differ significantly between the lacertus fibrosus and Achilles tendon group (12.3 ± 7.1 kPa vs 10.5 ± 5.7 kPa; P = .34). The primary mode of failure in the lacertus fibrosus group was suture pullout from the tissue at the musculotendinous junction (7 of 10). In the Achilles group, failures were observed at the muscle-allograft interface (3) and the allograft-bone (radial tuberosity) interface (3), and 3 suture failures were observed. The button fixation did not fail in any specimens. Conclusion: The mean stiffness and load-to-failure values were not significantly different between a lacertus fibrosus construct and Achilles tendon allograft. Clinical Relevance: Use of the lacertus fibrosus may be a potential alternative to Achilles tendon allograft reconstruction of chronic distal biceps tears when primary repair is not possible.

scholarly journals Return of an Intact Hook Test Result: Clinical Assessment of Biceps Tendon Integrity After Surgical Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982731 ◽  
Author(s):  
Graham D. Pallante ◽  
Shawn W. O’Driscoll
Keyword(s):  
Surgical Repair ◽  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Effective Manner ◽  
Distal Biceps Repair ◽  
Tendon Ruptures ◽  
Test Result

Background: The hook test is a sensitive and specific tool that has been previously described for diagnosing distal biceps tendon ruptures in an efficient, cost-effective manner. However, its application in postoperative evaluations after surgical repair of distal biceps tendon ruptures is not documented. Hypothesis/Purpose: We hypothesized that the hook test result returns to normal at some point postoperatively after distal biceps repair. This information could be used in decision making during follow-up examinations with both normal and abnormal findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively reviewed records of distal biceps repair. Between July 1, 2003, and July 1, 2016, a total of 56 patients underwent distal biceps repair and also had clear documentation of the results of the hook test during the postoperative period. Hook test results consisted of “intact,” “abnormal,” or “absent.” The timing of the return to a normal hook test result was recorded. Results: Overall, 51 of 57 (89%) repairs were documented to have the hook test result return to “intact.” The test result returned to intact by a mean of 10 weeks after surgery (range, 2 weeks to 15 months). The biceps tendon was intact according to the hook test at the 4-month follow-up in 45 of the 51 patients (88%) in whom it ultimately returned. The hook test result was abnormal in 5 repairs in 5 patients with only a short-term follow-up, ranging from 2 to 7 weeks postoperatively. One patient with an abnormal hook test result at 2 weeks postoperatively underwent revision and was confirmed to have a partial tear of the biceps insertion. His hook test result returned to intact 3 months after revision repair. Conclusion: The hook test result returns to normal in patients who undergo distal biceps repair in the primary and revision settings with adequate follow-up. The vast majority of patients have a normal hook test result by 4 months postoperatively. An abnormal hook test result at 4 months postoperatively may indicate a failed repair and should prompt further investigation.

Repair of Distal Biceps Tendon Ruptures Using Suture Anchors Through a Single Anterior Incision

2008 ◽  
Vol 24 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Abdul D. Khan ◽  
Sri Penna ◽  
Qi Yin ◽  
Chris Sinopidis ◽  
Peter Brownson ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Suture Anchors ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
Anterior Incision

Repair of Distal Biceps Tendon Ruptures Using a Suture Anchor and an Anterior Approach

2004 ◽  
Vol 29 (2) ◽  
pp. 178-182 ◽  
Author(s):  
L. BALABAUD ◽  
C. RUIZ ◽  
J. NONNENMACHER ◽  
P. SEYNAEVE ◽  
P. KEHR ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Suture Anchor ◽  
Single Incision ◽  
Biceps Tendon ◽  
Clinical Results ◽  
Distal Biceps Tendon ◽  
Isokinetic Testing ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
A Prospective Study

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

scholarly journals Gouty Tenosynovitis of the Distal Biceps Tendon Insertion Complicated by Partial Rupture

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. NP1-NP5 ◽  
Author(s):  
Rick J. Fairhurst ◽  
Arnold M. Schwartz ◽  
Leo M. Rozmaryn
Keyword(s):  
Tendon Rupture ◽  
Biceps Tendon ◽  
Partial Rupture ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
First Case ◽  
Biceps Tendon Rupture ◽  
History Of ◽  
Tendon Ruptures ◽  
Tendon Insertion

Background: Given the appreciable prevalence of gout, gout-induced tendon ruptures in the upper extremity are extremely rare. Although these events have been reported only 5 times in the literature, all in patients with a risk factor for or history of gout, they have conspicuously never been diagnosed in the shoulder or elbow. Methods: A 45-year-old, right-hand-dominant man with a history of gout presented with pain in his right anterior elbow and weakness in his forearm after a trivial injury. Results: Here, we report the first case of gouty tenosynovitis of the distal biceps tendon insertion complicated by partial rupture, a composite diagnosis supported by both intraoperative and histological observations. Conclusions: In patients who are clinically diagnosed with biceps tendon rupture and have a history of gout, it is important to consider the possibility of a gout-related pathological manifestation causing or simulating tendon rupture.

Endoscopic-Assisted Footprint Repair of Distal Biceps Tendon Ruptures

2021 ◽  
pp. 453-457
Author(s):  
Mina Derias ◽  
Gregory I. Bain ◽  
Joideep Phadnis
Keyword(s):  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures

Primary repair of retracted distal biceps tendon ruptures in extreme flexion

2014 ◽  
Vol 23 (5) ◽  
pp. 679-685 ◽  
Author(s):  
Mark E. Morrey ◽  
Matthew P. Abdel ◽  
Joaquin Sanchez-Sotelo ◽  
Bernard F. Morrey
Keyword(s):  
Primary Repair ◽  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures

An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon

2019 ◽  
Vol 28 (7) ◽  
pp. 2279-2284
Author(s):  
Kaare Sourin Midtgaard ◽  
Hanna Björnsson Hallgren ◽  
Karin Frånlund ◽  
Fredrik Gidmark ◽  
Endre Søreide ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Lacertus Fibrosus

scholarly journals Fixation of Acute Distal Biceps Tendon Ruptures Using Mitek Anchors: A Retrospective Study

2014 ◽  
Vol 8 (1) ◽  
pp. 52-55 ◽  
Author(s):  
M. Al-Taher ◽  
Diederick B. Wouters
Keyword(s):  
Biceps Brachii ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
Biceps Tendon Repair ◽  
Dash Questionnaire

Purpose of this Study: The aim of this study was to evaluate the outcomes of surgical intra-osseous fixation of the distal tendon of the ruptured biceps brachii muscle using Mitek anchors. Materials and Methods: Between 2005 and 2011, seven patients underwent unilateral distal biceps tendon repair using Mitek anchors. All patients were men aged between 36 and 47 years. Six patients were assessed by physical examination and use of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: Surgery was performed within 3 to 17 days of rupture with a mean follow-up of 35 months. Of the six fully completed DASH questionnaires, three patients had a score of 0, and three patients had scores of 5.8, 10 and 10.8, respectively (10.1 is the mean score for the general population). Transient paraesthesias in the lateral antebrachial cutaneous nerve region occurred in two patients and one patient experienced a transient stiffness of the elbow due to scarring of the wound. No major complicatons have occurred. Conclusion: The use of Mitek anchors for the re-insertion of the ruptured distal biceps tendon proved to be a safe and effective technique with excellent functional results in our series.

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